Health (Wisconsin)

When you receive care from a network PCP, there’s no deductible and care will be covered at 95% with no office visit copayment.

More importantly, your Primary Care Physician is the quarterback of your healthcare team.

A PCP can help you maintain and improve your health and provide direction for any specialist care you need.

If I do not enroll by my enrollment deadline, what coverage will I have?

If you are a new hire and you do not enroll by your enrollment deadline, you will have the following coverage by default:

Basic Life and AD&D insurance

Short-Term Disability Coverage

Long-Term Disability Coverage

Basic Medical Plan for yourself only with after-tax deductions for your portion of the cost of this coverage. This coverage will remain in effect for the rest of the calendar year. You cannot choose new options during the year unless you have a qualifying change in status.

If my doctor recommends that I receive care form a non-network provider, will that care be covered b

Services received from a non-network provider will be covered only if you first obtain a referral from your network provider and prior authorization from Dean Health Plan. Your network provider will need to submit a referral to Dean Health Plan to request coverage for treatment you receive from a provider who does not participate in your assigned network. If HealthEOS is your primary network, you will need a referral if the provider does not participate in either the HSHS/Prevea360 or HealthEOS networks.

Your network provider or Dean Health Plan may limit the number of visits, type of service or length of time for receiving services from a non-network provider. If you have questions about the referral process, contact Dean Health Plan at 888-895-1188.

What about emergency room care?

If your condition is a true emergency, you will have a $100 copayment for emergency services. This is in addition to your deductible and coinsurance for the medical plan option you select.

If you utilize the emergency room for a non-emergency condition, you will have a $300 copayment in addition to your deductible and coinsurance for the medical plan option you select.

For help determining which network service area you are in, see the 2018 Flexplan Benefits Guide or go to the HSHS Benefits Website at benefits.hshs.org to view the list of zip codes.

If you have a dependent who lives outside the state of Wisconsin, such as a child attending college, you are required to register your dependent with Dean Health Plan (1-888-895-1188) in order to have the national Multiplan network apply for your dependent’s HSHS Healthy Plan coverage.

When does health insurance coverage begin?

Your coverage will begin on the first day of a pay period following two full pay periods of employment.

The two full pay period waiting period applies if you are a newly hired colleague or have transferred from a PRN position to a benefits eligible position.

Coverage for your dependents begins on the same day as your coverage as long as you have enrolled them for health insurance.